股骨近端防旋髓內釘、動力髖螺釘、伽馬釘治療股骨轉子間骨折的系統評價_《華西醫學》

作者：

馬坤龍 ¹ , 王絢 ² , 欒富均 ¹ , 梁羽 ¹ , 張英杰 ² ,  方躍 ¹ , 屠重棋 ¹ , 楊天府 ¹

1四川大學華西醫院骨科（成都，610041）;2蘭州大學醫學院;

關鍵詞：

股骨轉子間骨折股骨近端抗旋髓內釘動力髖螺釘伽馬釘系統評價

DOI：

10.7507/1002-0179.20130113

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目的　評價股骨近端防旋髓內釘（PFNA）、動力髖螺釘（DHS）、伽馬釘治療股骨轉子間骨折的有效性和安全性。方法　計算機檢索Cochrane圖書館（2011年第12期），PubMed （1966年－2011年12月），EMBASE（1974年－2011年12月），web of science（1958年－2011年12月），萬方數據庫（1992年－2011年12月），維普資訊網（1989年－2011年12月），中國期刊全文數據庫（1994年－2011年12月），中國生物醫學文獻數據庫（1978年－2011年12月），納入PFNA、DHS、伽馬釘治療股骨轉子間骨折的隨機前瞻性研究，采取修訂后的Jadad評分量表對納入研究進行質量評價。用RevMan 5.1軟件進行Meta分析。結果　共納入12個研究（1 477例患者）。Meta分析結果顯示PFNA治療股骨轉子間骨折的手術時間[MD=?32.19，95%CI（?49.69，?14.69），P=0.000 3；MD=?4.52，95%CI（?5.24，?3.80），P＜0.000 01］，出血量[MD=?183.06，95%CI（?277.37，?88.74），P=0.000 1；MD=?49.49，95%CI（?84.15，?14.83），P=0.005]少于DHS組和伽馬釘組，但是三者在總有效率、住院時間和術后并發癥等方面差異無統計學意義。DHS組與伽馬釘組在所有指標差異均無統計學意義。結論　與DHS、伽馬釘相比，PFNA可明顯縮短手術時間、降低術中出血量，但并不能提高總有效率、縮短住院時間以及減少術后并發癥；而DHS與伽馬釘治療股骨轉子間骨折的療效無明顯差異。

引用本文： 馬坤龍,王絢,欒富均,梁羽,張英杰,方躍,屠重棋,楊天府. 股骨近端防旋髓內釘、動力髖螺釘、伽馬釘治療股骨轉子間骨折的系統評價. 華西醫學, 2013, 28(3): 345-351. doi: 10.7507/1002-0179.20130113 復制

1.	Zou J, Xu Y, Yang H. A comparison of proximal femoral nail antirotation and dynamic hip screw devices in trochanteric fractures[J]. J Int Med Res, 2009, 37(4): 1057-1064.
2.	Iqbal MM. Osteoporosis: epidemiology, diagnosis, and treatment[J]. South Med J, 2000, 93(1): 2-18.
3.	Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures[J]. Lancet, 2002, 359(9319): 1761-1767.
4.	Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies[J]. Instr Course Lect, 2004, 53: 441-454.
5.	劉海春, 陳允震, 楊子來, 等. 股骨粗隆間粉碎性骨折不同內固定療效分析[J]. 中國骨與關節損傷雜志, 2005, 20(1): 18-20.
6.	Peyser A, Weil YA, Brocke L, et al. A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip[J]. J Bone Joint Surg Br, 2007, 89(9): 1210-1217.
7.	Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures[J]. Int Orthop, 2003, 27(1): 11-17.
8.	王強, 王靜成, 蔣百川, 等. PFN與DHS治療股骨轉子間骨折的療效分析[J]. 實用臨床醫藥雜志, 2007, 11(11): 44-45.
9.	Dharmarajan TS, Banik P. Hip fracture. Risk factors, preoperative assessment, and postoperative management[J]. Postgrad Med, 2006, 119(1): 31-38.
10.	O’ Brien PJ, Meek RN, Blachut PA, et al. Fixation of intertrochanteric hip fractures Gamma nail versus dynamic hip screw.A randomised prospective study[J]. Can J Surg, 1995, 38(6): 516-520.
11.	曹烈虎, 劉欣偉, 蘇佳燦, 等. 應用動力髖螺釘、Gamma釘與股骨近端髓內釘治療高齡患者股骨轉子間骨折:隨機、前瞻設計95例隨訪分析[J]. 中國組織工程研究與臨床康復, 2009, 13(17): 3342-3346.
12.	范震波, 李健, 趙洪普, 等. 高齡股骨粗隆間骨折手術治療方法的療效分析[J]. 國際醫藥衛生導報, 2009, 15(11): 24-28.
13.	陳海良, 龐瑞明, 劉紅財, 等. PFNa治療骨質疏松性股骨轉子間骨折的臨床觀察[J]. 海南醫學院學報, 2011, 17(4): 532-534.
14.	Bridle SH, Patel AD, Bircher M, et al. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw[J]. J Bone Joint Surg Br, 1991, 73(2): 330-334.
15.	杜浩, 郭銳, 張曉強, 等. Gamma釘與DHS微創治療老年股骨轉子間骨折的前瞻性研究[J]. 中華骨科雜志, 2008, 28(8): 638-641.
16.	Adams CI, Robinson CM, Court-Brown CM, et al. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur[J]. J Orthop Trauma, 2001, 15(6): 394-400.
17.	董華. 兩種內固定方法治療老年股骨轉子問骨折的療效比較[J]. 中國當代醫藥, 2011, 18(20): 170-171.
18.	Xu Y, Geng D, Yang H, et al. Treatment of unstable proximal femoral fractures: comparison of the proximal femoral nail antirotation and gamma nail 3[J]. Orthopedics, 2010, 33(7): 473.
19.	Verettas DA, Ifantidis P, Chatzipapas CN, et al. Systematic effects of surgical treatment of hip fractures: gliding screw-plating vs intramedullary nailing[J]. Injury, 2010, 41(3): 279-284.
20.	Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients[J]. J Bone Joint Surg Am, 1998, 80(5): 618-630.
21.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg Am, 1969, 51(4): 737-755.
22.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17(1): 1-12.
23.	王春輝, 吳兵, 何方生, 等. 三種不同金屬植入物內固定治療老年股骨轉子間骨折99例的隨機對照[J]. 中國組織工程研究與臨床康復, 2011, 15(39): 7323-7326.
24.	Schipper IB, Steyerberg EW, Castelein RM, et al. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail[J]. J Bone Joint Surg Br, 2004, 86(1): 86-94.
25.	Menezes DF, Gamulin A, Noesberger B. Is the proximal femoral nail a suitable implant for treatment of all trochanteric fractures?[J]. Clin Orthop Relat Res, 2005, 439(439): 221-227.
26.	Curtis MJ, Jinnah RH, Wilson V, et al. Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation[J]. Injury, 1994, 25(2): 99-104.
27.	Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation[J]. Injury, 2006, 37(10): 984-989.
28.	Simmermacher RK, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study[J]. Injury, 2008, 39(8): 932-939.
29.	Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures[J]. Injury, 2009, 40(4): 428-432.
30.	Butt MS, Krikler SJ, Nafie S, et al. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial[J]. Injury, 1995, 26(9): 615-618.
31.	Saarenpää I, Heikkinen T, Ristiniemi J, et al. Functional comparison of the dynamic hip screw and the Gamma locking nail in trochanteric hip fractures: a matched-pair study of 268 patients[J]. Int Orthop, 2009, 33(1): 255-260.
32.	Parker MJ, Pryor GA. Gamma versus DHS nailing for extracapsular femoral fractures. Meta-analysis of ten randomised trials[J]. Int Orthop, 1996, 20(3): 163-168.
33.	趙巖, 霍建軍, 田禾, 等. 動力髖與Gamma釘治療成人股骨粗隆間骨折療效Meta分析[J]. 中國骨與關節損傷雜志, 2011, 26(8): 697-701.
34.	霍建軍, 趙巖, 田禾, 等. Gamma釘與動力髖治療老年股骨粗隆間骨折的系統評價[J]. 中國現代醫學雜志, 2011, 21(7): 773-778.

1. 　Zou J, Xu Y, Yang H. A comparison of proximal femoral nail antirotation and dynamic hip screw devices in trochanteric fractures[J]. J Int Med Res, 2009, 37(4): 1057-1064.
2. 　Iqbal MM. Osteoporosis: epidemiology, diagnosis, and treatment[J]. South Med J, 2000, 93(1): 2-18.
3. 　Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures[J]. Lancet, 2002, 359(9319): 1761-1767.
4. 　Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies[J]. Instr Course Lect, 2004, 53: 441-454.
5. 　劉海春, 陳允震, 楊子來, 等. 股骨粗隆間粉碎性骨折不同內固定療效分析[J]. 中國骨與關節損傷雜志, 2005, 20(1): 18-20.
6. 　Peyser A, Weil YA, Brocke L, et al. A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip[J]. J Bone Joint Surg Br, 2007, 89(9): 1210-1217.
7. 　Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures[J]. Int Orthop, 2003, 27(1): 11-17.
8. 　王強, 王靜成, 蔣百川, 等. PFN與DHS治療股骨轉子間骨折的療效分析[J]. 實用臨床醫藥雜志, 2007, 11(11): 44-45.
9. 　Dharmarajan TS, Banik P. Hip fracture. Risk factors, preoperative assessment, and postoperative management[J]. Postgrad Med, 2006, 119(1): 31-38.
10. 　O’ Brien PJ, Meek RN, Blachut PA, et al. Fixation of intertrochanteric hip fractures Gamma nail versus dynamic hip screw.A randomised prospective study[J]. Can J Surg, 1995, 38(6): 516-520.
11. 　曹烈虎, 劉欣偉, 蘇佳燦, 等. 應用動力髖螺釘、Gamma釘與股骨近端髓內釘治療高齡患者股骨轉子間骨折:隨機、前瞻設計95例隨訪分析[J]. 中國組織工程研究與臨床康復, 2009, 13(17): 3342-3346.
12. 　范震波, 李健, 趙洪普, 等. 高齡股骨粗隆間骨折手術治療方法的療效分析[J]. 國際醫藥衛生導報, 2009, 15(11): 24-28.
13. 　陳海良, 龐瑞明, 劉紅財, 等. PFNa治療骨質疏松性股骨轉子間骨折的臨床觀察[J]. 海南醫學院學報, 2011, 17(4): 532-534.
14. 　Bridle SH, Patel AD, Bircher M, et al. Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw[J]. J Bone Joint Surg Br, 1991, 73(2): 330-334.
15. 　杜浩, 郭銳, 張曉強, 等. Gamma釘與DHS微創治療老年股骨轉子間骨折的前瞻性研究[J]. 中華骨科雜志, 2008, 28(8): 638-641.
16. 　Adams CI, Robinson CM, Court-Brown CM, et al. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur[J]. J Orthop Trauma, 2001, 15(6): 394-400.
17. 　董華. 兩種內固定方法治療老年股骨轉子問骨折的療效比較[J]. 中國當代醫藥, 2011, 18(20): 170-171.
18. 　Xu Y, Geng D, Yang H, et al. Treatment of unstable proximal femoral fractures: comparison of the proximal femoral nail antirotation and gamma nail 3[J]. Orthopedics, 2010, 33(7): 473.
19. 　Verettas DA, Ifantidis P, Chatzipapas CN, et al. Systematic effects of surgical treatment of hip fractures: gliding screw-plating vs intramedullary nailing[J]. Injury, 2010, 41(3): 279-284.
20. 　Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients[J]. J Bone Joint Surg Am, 1998, 80(5): 618-630.
21. 　Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg Am, 1969, 51(4): 737-755.
22. 　Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17(1): 1-12.
23. 　王春輝, 吳兵, 何方生, 等. 三種不同金屬植入物內固定治療老年股骨轉子間骨折99例的隨機對照[J]. 中國組織工程研究與臨床康復, 2011, 15(39): 7323-7326.
24. 　Schipper IB, Steyerberg EW, Castelein RM, et al. Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail[J]. J Bone Joint Surg Br, 2004, 86(1): 86-94.
25. 　Menezes DF, Gamulin A, Noesberger B. Is the proximal femoral nail a suitable implant for treatment of all trochanteric fractures?[J]. Clin Orthop Relat Res, 2005, 439(439): 221-227.
26. 　Curtis MJ, Jinnah RH, Wilson V, et al. Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation[J]. Injury, 1994, 25(2): 99-104.
27. 　Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation[J]. Injury, 2006, 37(10): 984-989.
28. 　Simmermacher RK, Ljungqvist J, Bail H, et al. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study[J]. Injury, 2008, 39(8): 932-939.
29. 　Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures[J]. Injury, 2009, 40(4): 428-432.
30. 　Butt MS, Krikler SJ, Nafie S, et al. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial[J]. Injury, 1995, 26(9): 615-618.
31. 　Saarenpää I, Heikkinen T, Ristiniemi J, et al. Functional comparison of the dynamic hip screw and the Gamma locking nail in trochanteric hip fractures: a matched-pair study of 268 patients[J]. Int Orthop, 2009, 33(1): 255-260.
32. 　Parker MJ, Pryor GA. Gamma versus DHS nailing for extracapsular femoral fractures. Meta-analysis of ten randomised trials[J]. Int Orthop, 1996, 20(3): 163-168.
33. 　趙巖, 霍建軍, 田禾, 等. 動力髖與Gamma釘治療成人股骨粗隆間骨折療效Meta分析[J]. 中國骨與關節損傷雜志, 2011, 26(8): 697-701.
34. 　霍建軍, 趙巖, 田禾, 等. Gamma釘與動力髖治療老年股骨粗隆間骨折的系統評價[J]. 中國現代醫學雜志, 2011, 21(7): 773-778.

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股骨近端防旋髓內釘、動力髖螺釘、伽馬釘治療股骨轉子間骨折的系統評價

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